Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on Atrial Fibrillation

Nieuwlaat, Robby; Prins, Martin H.; Heuzey, Jean‐Yves Le; Vardas, Panos; Aliot, Étienne; Santini, Massimo; Cobbe, Stuart M.; Widdershoven, Jos; Baur, L.H.B.; Lévy, Samuel; Crijns, Harry J.G.M.

doi:10.1093/eurheartj/ehn139

Cited by 247 publications

(209 citation statements)

References 23 publications

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“…13 However, this is only in individuals in whom a diagnosis of AF has already been made because they present with symptoms. It is estimated that, of those with persistent AF, one-third will not have symptoms 14 and therefore a first presentation of persistent AF might be a stroke. It is these individuals who would benefit most from anticoagulation therapy for stroke prevention, and underdetection of AF in this population represents a major gap in clinical care.…”

Section: Discussionmentioning

confidence: 99%

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Welton

McAleenan

Thom

et al. 2017

Health Technol Assess

118

122

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BackgroundAtrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of thromboembolic events. Anticoagulation therapy to prevent AF-related stroke has been shown to be cost-effective. A national screening programme for AF may prevent AF-related events, but would involve a substantial investment of NHS resources.ObjectivesTo conduct a systematic review of the diagnostic test accuracy (DTA) of screening tests for AF, update a systematic review of comparative studies evaluating screening strategies for AF, develop an economic model to compare the cost-effectiveness of different screening strategies and review observational studies of AF screening to provide inputs to the model.DesignSystematic review, meta-analysis and cost-effectiveness analysis.SettingPrimary care.ParticipantsAdults.InterventionScreening strategies, defined by screening test, age at initial and final screens, screening interval and format of screening {systematic opportunistic screening [individuals offered screening if they consult with their general practitioner (GP)] or systematic population screening (when all eligible individuals are invited to screening)}.Main outcome measuresSensitivity, specificity and diagnostic odds ratios; the odds ratio of detecting new AF cases compared with no screening; and the mean incremental net benefit compared with no screening.Review methodsTwo reviewers screened the search results, extracted data and assessed the risk of bias. A DTA meta-analysis was perfomed, and a decision tree and Markov model was used to evaluate the cost-effectiveness of the screening strategies.ResultsDiagnostic test accuracy depended on the screening test and how it was interpreted. In general, the screening tests identified in our review had high sensitivity (> 0.9). Systematic population and systematic opportunistic screening strategies were found to be similarly effective, with an estimated 170 individuals needed to be screened to detect one additional AF case compared with no screening. Systematic opportunistic screening was more likely to be cost-effective than systematic population screening, as long as the uptake of opportunistic screening observed in randomised controlled trials translates to practice. Modified blood pressure monitors, photoplethysmography or nurse pulse palpation were more likely to be cost-effective than other screening tests. A screening strategy with an initial screening age of 65 years and repeated screens every 5 years until age 80 years was likely to be cost-effective, provided that compliance with treatment does not decline with increasing age.ConclusionsA national screening programme for AF is likely to represent a cost-effective use of resources. Systematic opportunistic screening is more likely to be cost-effective than systematic population screening. Nurse pulse palpation or modified blood pressure monitors would be appropriate screening tests, with confirmation by diagnostic 12-lead electrocardiography interpreted by a trained GP, with referral to a specialist in the case of an unclear diagnosis. Implementation strategies to operationalise uptake of systematic opportunistic screening in primary care should accompany any screening recommendations.LimitationsMany inputs for the economic model relied on a single trial [the Screening for Atrial Fibrillation in the Elderly (SAFE) study] and DTA results were based on a few studies at high risk of bias/of low applicability.Future workComparative studies measuring long-term outcomes of screening strategies and DTA studies for new, emerging technologies and to replicate the results for photoplethysmography and GP interpretation of 12-lead electrocardiography in a screening population.Study registrationThis study is registered as PROSPERO CRD42014013739.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Discussionmentioning

confidence: 99%

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Welton

McAleenan

Thom

et al. 2017

Health Technol Assess

118

122

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“…The progression of the arrhythmia towards more refractory forms seems to be related both to underlying conditions and to the extent of atrial remodelling [39]. Identifying biomarkers of atrial fibrillation progresssion would most benefit patients who present with asymptomatic atrial fibrillation.…”

Section: Discussionmentioning

confidence: 99%

Biomarkers and atrial fibrillation: A new paradigm for assessing the progression of left atrial endocardial remodelling

Chevalier¹,

Scridon²

2012

OJCD

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Atrial fibrillation is a heterogeneous disorder that is usually characterized by paroxysmal onset, particularly in patients without structural heart disease. Defining biological markers of atrial remodelling would help identify patients at high risk who would benefit most from prophylactic treatment and careful monitoring. Biomarkers of atrial fibrillation progression would be helpful for following patients that present with asymptomatic atrial fibrillation. Notably, the roles of such markers in the pathophysiology of atrial fibrillation must be determined. Some markers may indicate the presence, complications or progression of the disease, while others may be involved in key pathological processes and thus represent novel therapeutic targets. Although a number of markers have been reported as potential predictors of paroxysmal atrial fibrillation progression towards persistent arrhythmia, their usefulness and clinical value need further validation. This report reviews several newly identified markers of atrial fibrillation progression.

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“…No measure of adiposity was associated with a different risk of bleeding. Among possible explanations for this finding are an earlier more rigorous use of co-medications and life-style modification 19 and better metabolic reserve, 20 which may ultimately affect intermediateterm prognosis in obese patients.…”

Section: Stroke Preventionmentioning

confidence: 99%

The year in cardiology 2016: arrhythmias and cardiac implantable electronic devices

Cappato¹,

Hindricks

Steffel

2017

Cardiologia Croatica

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Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on Atrial Fibrillation

Abstract: The EHS on AF provides unique prospective observational data on AF progression, long-term treatment, prognosis, and determinants of adverse outcome of the total clinical spectrum of AF in a European cardiology-based patient cohort.

Cited by 247 publications

References 23 publications

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Biomarkers and atrial fibrillation: A new paradigm for assessing the progression of left atrial endocardial remodelling

The year in cardiology 2016: arrhythmias and cardiac implantable electronic devices

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